RN Case Manager


San Marcos, CA

What you'll be doing

The RN case manager evaluates and identifies member needs. S/he interfaces with primary care physicians, specialists, and various disciplines on the development of case management plans/programs. Monitors and evaluates the effectiveness of the case management plans and modifies as necessary. S/he coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families. The candidate acts as a clinical liaison, per specialty, with outside agencies such as county CCS, non-plan facilities, outside providers, employers, and/or workers compensation carriers, and third party administrators. Prepares reports, communicates program changes to appropriate staff, and develops protocols in accordance with state regulations. Develops individualized patient/family education plan focused on self-management; delivers patient/family education specific to a disease state. S/he consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies. S/he participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards. Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service. The applicant ensures that accurate records maintained of the care associated with each patient. This position interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies. S/he performs other duties as assigned.

What your background should be

The candidate with minimum 2 years of clinical experience as an RN in an acute care or ambulatory care setting required. Current California RN license and BLS required. Previous 2 years of case management experience in chronic disease case management preferred. Applicant should have working knowledge of regulatory requirements and accreditation standards (TJC, Medicare). Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills required. Computer literacy skills required. Case management certification or certification in the area of specialty preferred. Must have excellent customer service skills and be able to work collaboratively with primary care and specialty departments.

Required Schooling / Training

Bachelor degree or 4 years of equivalent experience required.

Who is the client company

This is an integrated and one of the largest managed care organization in the United States.
If you are interested in this position, send your resume to apply@kochdavis.com